Atrophy of Inner Thigh

[Dr Damien]

Dear Browntrout(Jim)

Your symptoms sound like they are truly originating from L3/L4. Definitely cant give you any exercises without assessing first however some aims of treatment and some goals for rehabilitation can be set:
1) reduce the sensation of numbness experienced (this may not change if it has been a very longstanding problem)
2) improve the strength of the adductor group of muscles
3)decrease pain in the back

Goals from rehabilitation could be lets say for instance
1) to be a ble to climb up and down the stairs with one rail support or no support
2) to be able to climb up and down with a reciprocal pattern
3) reduce risk of falling

when you cycle are you using any resistance or are you riding on the same intensity? sometimes when you ride a bike, there is temporary weakness when the muscle is fatigued...
what you need is progressive strengthening program, that eliminates the possibility of fatigue...i had a patient once who fractured her thigh bone and was in a cast for 6-12 weeks, she also had a history of polio...when we tried to strengthen her thigh muscles by using a stationary bike, she always had a weakness immediately after that made walking difficult, however this weakness did not last...the muscles will get stronger but they need to be challenged appropriately otherwise you will not be building more fibers or firing as much of the fibers as you need...so think about setting the intensity to something comfortable...but not too easy (it should feel difficult butyou should be able to cycle it)...cycle fo short periods...but repeat often...then gradually increase the intensity regularly...
you can also strengthen the adductor muscles specifically by squeezing a ball between your thighs, holding for 10seconds...repeat maybe five times...do often in a day...gradually increase time you squeeze...
you could also lie down on your back, bend the good leg so that the foot is flat...keep the bad leg straight...try to lift off the floor then move it across your body slowly...do five times, gradually build over time...
in time you can can progress this exercise to the test position described in the previous entry...or involve the use of a resistance band

the idea is you need to challenge the muscles to get them to change their physiology, repeating the same intensity will improve to a level then no other improvements will be seen...the ideas ive suggested above are not written in stone...its the idea that is relevant, whatever works for you with regards reps is perhaps what is more approprite

NOTE: these exercises can influence your back, so you need to have your back well supported when doing any leg raises...

Because there is a possibility of some tightness of your iliopsoas muscle...you need a good assessment to see if this is overactive or tight...

You may benefit from some lumbar stabilization exercises...to generally mobilize and strengthen your spine...
some stretches in lying or sideflexion may be required...some therapists are skilled in manual therapy to help release tight muscles

electrical stimulation can be done with a physio in adition to any manual therapy work...to stimulate the nerves and get them to fire...FES may be more appropriate...

you could also try some balance exercises...wherein the aim would be to be able to ultimately one leg stand...with or without minimal support...

if you have goals set in place, and you are achieving them then your rehabilitation is working...you dont have to set the same goals i have suggested, its the goals that mean something to you thats important, I have only picked these goals based on what you seem to have trouble with..

you really need to work with a therapist, you have tried two professionals only...there are therapists out there who are rehab oriented...and can help you achieve any goals you set, its perhaps better to seek the one with core skills in musculoskeletal/manual therapy....

Did you have any physio after your surgeries?

[BrownTrout]

Dr. Damien,
I had successful physical therapies after all my surgeries except this last one a year ago. I went to the PT at the local hospital a couple of months after the surgery and he reviewed the neurosurgeon's notes and told me he couldn't help me. That was very discouraging to hear.

I visited another PT a month ago just to see if he thought he could help. He suggested I roll up a towel and put it under my left waist and just relax on the floor for 5 minutes. Said to repeat this if it provided relief and to quit if it hurt. He thought this would help separate the vertebrae that might still be pinching the sciatic nerve. After the first time, it made matters worse (more pain). Tried it again the next day with the same results so I quit that "exercise".

Just seems like those I've visited with so far truly do not understand the nature of my problem and, therefore, are not providing realistic remedies. Maybe I should just return to the neurosurgeon, get another MRI, have him define the problem for me and recommend therapy from someone in their clinic (Springfield Neurological and Spine Institute in Springfield, MO). I'd have done this already but I feel he will just want to operate again, not to mention it's a 3 hour drive to the clinic.

I've done some of the exercises you mentioned in your last post. For example, squeezing a ball between my thighs. I'll also try some of the others you mentioned.

Jim

[BrownTrout]

Forgot to mention that along with the exercises I've been doing to strengthen the leg, I've been addressing the pain by laying flat on the floor with my legs up on a chair and alternating heat and ice packs. This seems to work . . . . for short periods anyway.

Jim